Aortic insufficiency after Arterial Switch Operation in Transposion of the Great Arteries

ABSTRACT

BACKGROUND: The arterial switch operation (ASO) has become a procedure of choice for transposition of the great arteries (TGA) with or without ventricular septal defect (VSD). In spite of current low surgical mortality in immediate surgical period, there are potential problems of late morbidity and mortality. In this study, we evaluate the prevalence and severity of aortic insufficiency (AI) and associated factors with AI. METHOD: We retrospectively reviewed medical records and echocardiogram of 125 patients (M89, F36) underwent ASO for TGA at Seoul National University Children's Hospital from July, 1987 to June, 1997. To evaluate for associated factors, we divided patients of TGA to four hemodynamic groups (Group I, simple TGA (n-53); Group II, associated with ventricular septal defect (VSD) (n-50); Group III, associated with VSD and PS (n-18); Group IV, associated with PS (n-4)). Grade of AI was assessed by color Doppler analysis (Perry's et al). RESULTS: Total prevalence rate of AI was 35.2% (31/88) and grade of AI were mild in 61%, moderate in 39%. The incidence of AI in each group was Group I 25.0% (10/40), Group II 26.0% (9/36), Group III 92.0% (12/13). According to this study, pulmonary stenosis was the only significant factor to AI. During follow-up (39+/-24 Months), in spite of the normal left ventricular function in most patients with AI, a few patients (3 cases) suffered from progressive AI and some moderate AI patients (2 cases) showed slightly decreased LV function. Two moderate and progressive AI lossed. CONCLUSION: In this study, AI (after ASO) was not uncommon and pulmonary stenosis was an important factor to AI. In some cases, AI became worse and developed decreased LV function. This suggests that meticulous follow-up after ASO is necessary.